Harvest of Sorrow

Christopher Hitchens tells the possibly (probably) apocryphal story of Robert Conquest, the historian: after writing a first book on the brutalities of Soviet socialism, The Great Terror: Stalin’s Purges of the 1930s, Conquest submitted a second as-yet untitled manuscript on Stalin’s program of forced collectivization.  Asked what he wanted to call it, he came up with the ungracious and yet apt title, I Told You So, You Fucking Fools. The book was, in the end, called The Harvest of Sorrow: Soviet Collectivization and the Terror Famine, followed by a third, Stalin: Breaker of Nations. 

I lack Robert Conquest’s erudition, productivity, or grace, but I do have one thing in common with him: I told you so, too–not about Stalin, but about “football,” i.e., American football, a bloodsport whose deceptions begin with its name. Continue reading

Preferential Treatment in the ER?

Today’s New York Times has a well-written, informative, and potentially explosive article, “How NYU’s Emergency Room Favors the Rich.” Here’s a summary, but read the whole thing for the full scoop:

In New York University’s busy Manhattan emergency department, Room 20 is special.

Steps away from the hospital’s ambulance bay, the room is outfitted with equipment to perform critical procedures or isolate those with highly infectious diseases.

Doctors say Room 20 is usually reserved for two types of patients: Those whose lives are on the line. And those who are V.I.P.s.

NYU Langone denies putting V.I.P.s first, but 33 medical workers told The New York Times that they had seen such patients receive preferential treatment in Room 20, one of the largest private spaces in the department. One doctor was surprised to find an orthopedic specialist in the room awaiting a senior hospital executive’s mother with hip pain. Another described an older hospital trustee who was taken to Room 20 when he was short of breath after exercising.

The privileged treatment is part of a broader pattern, a Times investigation found. For years, NYU’s emergency room in Manhattan has secretly given priority to donors, trustees, politicians, celebrities, and their friends and family, according to 45 medical workers, internal hospital records and other confidential documents reviewed by The Times.

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Bras, Breasts, Feminism, and Life Support

Not long ago, while applying for hospital-based jobs, it occurred to me that I lacked a certification that I really ought to have, namely, Basic Life Support, or BLS. From the website of the American Red Cross:

Basic Life Support, or BLS, generally refers to the type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway. It requires knowledge and skills in cardiopulmonary resuscitation (CPR), using automated external defibrillators (AED) and relieving airway obstructions in patients of every age.

So I signed up for a class in my area, and decided to certify. It was relatively cheap, conveniently located, and scheduled to take all of four hours. A bargain. Continue reading

Life Imitates Art

The 2002 film “John Q” begins with a scene in which a reckless driver dies, clearly at fault, in a horrific car wreck. Her organs, including her heart, are “harvested” or “recovered,” depending on your preferred choice of medical terminology, for purposes of organ donation. That organ recovery drives the plot of the rest of the film, which involves–somewhat heavy-handedly–the transplant of that very heart into a totally unrelated person dying of heart disease. In short, one person’s recklessness becomes her tragic demise; that tragedy becomes another person’s salvation.

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Markets, Uncertainty, and Health Care

After about a year and a half of working in health care, and at least some casual reading of the relevant literature, I’m increasingly skeptical that a libertarian free market can provide an adequate basis for the provision of health care. The longer I work in the field, the more convinced I become of the essential truth of Kenneth Arrow’s famous insight about the economics of health care: 

[T]he special economic problems of medical care can be explained by adaptations to uncertainty in the incidence of disease and in the efficacy of treatment (emphasis added).* 

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Novak Djokovic: Cancelled

I’ve defended both the idea of cancellation in the abstract, as well as specific cancellations, done in specific ways, on this blog. My critics have done an end-run around what I’ve actually said about cancellation, as well as the examples I’ve adduced, focusing on the unintended consequences of cancellation that lead, or supposedly lead, to “lynch mobs,” the “thought police,” and the like.*

I still have a great deal more to say about cancellation as both a philosophical and a historical matter, but in honor of one of the greatest cancelers in American history, Martin Luther King Jr (whose birthday is celebrated tomorrow), I’ve decided to descend to casuistry and inaugurate Cancel Week: a week of posts devoted to nothing but cancellations and anti-cancellations. (Sotto voce confession: I have a lot more than seven examples at my disposal, so this “week” may last awhile. But if revolutionism entails revisionism, revisionism about the meaning of “week” is to be expected.)

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Omicron, Delta, and the Revenge of Count von Count

I heard today from a physician whose hospital is on the verge of collapse, and an ICU nurse at a different hospital who is likely struggling with COVID, but being instructed not to get tested so as not to miss work. Two fairly typical stories from the edge of the healthcare abyss, but entirely predictable and a long time in the making. “Hospitals are understaffed” is now common knowledge, not a news story. The question is why. There’s no way to answer that question in the absence of information about staffing and budget decisions, themselves connected to facts about medical billing and collecting. This article is a case in point.

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Fatal Vision: Boosters, Variants, and Equity

Getting a booster is no panacea, but not getting one may be a fatal mistake. That, at any rate, is the finding of a set of Israeli studies in the New England Journal of Medicine, one published in October, the other published just a few days ago. An excerpt from the abstract of the “Conclusions” section of the latter:

Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.

Read both articles all the way through for all of the relevant provisos and qualifications, but I think it’s fair to summarize both by saying that they jointly found that boosters reduced the incidence of both serious morbidity and mortality due to COVID-19, inclusive of all variants but Omicron (about which it’s too early to tell). Continue reading